Remission of persistent childhood asthma: Early predictors of adult outcomes - 04/05/19
Abstract |
Background |
Few data exist on the predictors of asthma remission by early adulthood in North America.
Objective |
The predictors of adult asthma remission were determined in a multiethnic population of patients with mild-to-moderate persistent childhood asthma.
Methods |
Asthma remission in early adulthood was measured by using 2 definitions: a clinical and a strict definition. Both included normal lung function and the absence of symptoms, exacerbations, and medication use. The strict definition also included normal airways responsiveness. Predictors were identified from 23 baseline measures by using multivariate logistic regression. The probability of remission was modeled by using decision tree analysis.
Results |
In 879 subjects the mean ± SD baseline age was 8.8 ± 2.1 years, 59.4% were male, and 68.7% were white. By adulthood, 229 (26.0%) of 879 participants were in clinical remission, and 111 (15.0%) of 741 participants were in strict remission. The degree of FEV1/forced vital capacity (FVC) ratio impairment was the largest predictor of asthma remission. More than half of boys and two thirds of girls with baseline FEV1/FVC ratios of 90% or greater were in remission at adulthood. Decreased airways responsiveness was also a predictor for both remission definitions (clinical remission odds ratio, 1.23 [95% CI, 1.09-1.39]; strict remission odds ratio, 1.52 [95% CI, 1.26-1.84]). The combination of normal FEV1/FVC ratio, airways responsiveness, and serum eosinophil count at baseline yielded greater than 80% probability of remission by adulthood.
Conclusion |
A considerable minority of patients with persistent childhood asthma will have disease remission by adulthood. Clinical prognostic indicators of asthma remission, including baseline lung function, can be seen from an early age.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : Pediatric asthma, asthma remission, prognostication
Abbreviations used : AUC, BHR, CAMP, FVC, OR
Plan
Supported by National Institutes of Health (NIH) grants T32 AI007306, T32 HL007427, R01 HL127332, R01 HL129935, and U01 HL65899. The Childhood Asthma Management Program (CAMP) trial and CAMP Continuation Study were supported by contracts NO1-HR-16044, 16045, 16046, 16047, 16048, 16049, 16050, 16051, and 16052 with the National Heart, Lung, and Blood Institute and General Clinical Research Center grants M01RR00051, M01RR0099718-24, M01RR02719-14, and RR00036 from the National Center for Research Resources. The CAMP Continuation Study/Phases 2 and 3 were supported by grants U01HL075232, U01HL075407, U01HL075408, U01HL075409, U01HL075415, U01HL075416, U01HL075417, U01HL075419, and U01HL075420 from the National Heart, Lung, and Blood Institute. The National Jewish Health site was also supported in part by Colorado CTSA grant UL1RR025780 from the National Center for Research Resources/NIH and UL1TR000154 from National Center for Advancing Translational Sciences/NIH. |
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Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest. |
Vol 143 - N° 5
P. 1752 - mai 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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